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Abstract: Objective: To evaluate recruitment manoeuvre (RM) efficiency associated with a 10cmH2O positive end expiratory pressure (PEEP) on respiratory mechanic estimated by lung compliance (Ctp) and PEEP to ZEEP expiratory volume delta (Δ VTE) during laparoscopic bariatric surgery in patients with morbid obesity. Study design: Prospective randomized study. Methods: Twenty-six obese patients (BMI>40kg/m2) undergoing laparoscopic bariatric surgery. The recruitment group received an RM followed by a 10cmH2O PEP versus only 10cmH2O PEP in the control group. Ctp was measured during the intervention and functional residual capacity (FRC) was estimated measuring Δ VTE during a PEP to ZEP manoeuvre. Mann and Whitney tests as well as a t-test were used (significance p <0.05). Results: In the RM group, a significant improvement of 52±14ml/cmH2O was noted versus a 36±10ml/cmH2O in the PEP group (p =0,004). This improvement was transitory and no statistically significant Δ VTE difference was noted between the groups at the end of the intervention (360 [90–770]ml [MRA] and 310 [190–450]ml [PEP]). Conclusion: In patients with morbid obesity undergoing laparoscopic bariatric surgery, an RM conducted prior the pneumoperitoneum temporarily improves lung mechanics but without any change of the end expiratory lung volume at the end of the surgery in comparison with PEP alone. The RM was well tolerated. [Copyright &y& Elsevier]

Abstract: The considerable progress, performed for more than 30 years, in paediatric and interventional cardiology, imaging, surgery, anaesthesia and critical care in the congenital heart diseases allowed the survival the adulthood of more than 85 % of the affected children. The univentricular repair in total cavopulmonary connection or Fontan procedure, are realized in three stages, now, before the age of 5 years, with a different physiology after each stage. This point makes anaesthetic care more complicated for a non-cardiac surgery. The precise knowledge of the physiology of the “Fontan” is necessary before proceeding with anaesthesia. It allows to anticipate the pitfalls and to define specific strategies to be applied. [Copyright &y& Elsevier]

Abstract: Objectives: Assess the impact on the quality of practices in a developing country (Lao Democratic People''s Republic) of a long specialized course in anaesthesia (Certificate of Specialized Studies in Anesthesia-Intensive care and Emergency Medicine [Cesarmu]) versus accelerated trainings. Population and method: Study concerned all surgical hospitals and all anaesthesiologists of Lao PDR. At hospital level, the quality of care was assessed and compared between hospitals with and without Cesarmu anaesthetists by using the quality of anaesthesia record and the spinal anaesthesia frequency in lower gyneco-obstetrical surgery. On an individual level, we assessed and compared anaesthetists who were Cesarmu trained and those who were not by using theoretical and practical scores. The latter were acquired by observing complete perisurgical care (pre-, per- and postoperative practical scores). Results: We visited 29 of the 34 surgical hospitals in Lao PDR and met 90 of the 111 anesthesiologists. At hospital level, quality criteria were higher in the group of hospitals with Cesarmu anaesthesiologists without that difference being significant. On the other hand, all individual scores measured were significantly higher in the Cesarmu group. Discussion: The improvement of practices resulting from training was obvious at the individual level but its impact at hospital level was not significant. There were most likely not enough trained anaesthetists to significantly influence practices in their departments. Conclusion: According to the criteria used, the impact of Cesarmu on the quality of anaesthesia in Lao PDR seems positive. However, training needs to be continued and practices homogenized. [Copyright &y& Elsevier]